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<p>The fatal weakness public programs have is lack of fiscal responsibility. If the middleman insurance company dishes out top dollar services while collecting inadequate premiums, they go out of business, so there is a force to keep them looking at income and expenses. Public programs can be pressured to disconnect spending and collecting, resulting in the mess that we have.</p>
<p>“No point in caterwauling about it.”</p>
<p>Hey, I don’t thing I caterwaul about that as much as I do about other kinds of social services. </p>
<p>But what makes medicine different to me (and I know I only walk in my shoes), is that unlike legal services, everybody feels not just health care, but the best care, as defined by folks with a dozen different agendas, is a right. What other business is like that?</p>
<p>Who questions their lawyer or financial planner about billing for a phone call, or by the minute? Who complains that they have to pay for their plane ticket, even if they miss the plane?</p>
<p>“Perhaps this is because private practices are economically inefficient. If doctors can pool equipment and resources to reduce costs, then this should be done.”</p>
<p>Financially that makes sense, but the bigger the “pool”, the less room for individual decision making, and the less room for different folks definition of “good medicine”. I don’t have a problem with delivering “pooled” resources, but I don’t like the part where the pooled decision making doesn’t jibe with the latest advice from your “clients” favorite forum.</p>
<p>It would be interesting to get an actual, unbiased picture of healthcare in Canada, with no ideological spin. You hear people raving about Canada’s system over here (who don’t have to pay the heavy taxes on it). But it seems like every time I travel to Canada, I’m reading in the papers about long waits for serious surgeries, and people having to travel to the US to get treatment. About people who are enroute to their surgeries, and told, tough luck someone else has higher priority than you. Go back on the waiting list. Is the health care based on the province, the city, the hospital, the disease? If you need emergency service, no problem, you knock someone else out of line, but if you’re not dying, you might be out of luck?</p>
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<p>I’m from Singapore, which has a higher economic freedom rating than America, but yet has an excellent universal healthcare system.</p>
<p>gtalum… probably because the stats i have seen on physician salaries are usually gross income… if in private practice the net income is much lower…</p>
<p>“If you need emergency service, no problem, you knock someone else out of line, but if you’re not dying, you might be out of luck?”</p>
<p>The people in my company had long-term, chronic health conditions, such as Parkinson’s and lupus, as well as difficult births, and, as noted, cancer surgery. All in British Columbia. All of them get fantastic care (in the case of the first two, integrated holistic care of the type that no insurance company that I know of in the U.S. would cover), available without waiting, through doctors of their own choice. Why should I be biased? My company depended on these employees getting their care they needed, and they did.</p>
<p>(As I’ve written about previously, here, with the highest rated insurance plan in the Pacific Northwest, we were lied to, denied service, and finally received the care needed for my younger d. after a 10-month wait (and only after changing insurance companies) for a short operation for a simple condition which, left untreated, perhaps cost her $200k in college scholarships, plus untold pain.)</p>
<p>(Wait til I get over my huff to tell you about our latest “adventures”.)</p>
<p>^^ I wasn’t referring to you specifically as being biased. I was speaking in generalities.</p>
<p>I would not consider an unbiased opinion to come from those who have a general feeling of, “This country does things worse than most other countries.” Nor would I consider an unbiased opinion to be, “This country does everything better than other countries.” As my son says…you can see so clearly when you take politics out of the equation.</p>
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<p>Fair enough, I’m just one person. More objective data is reflected in the per capita expenditures, survival rates, longevity. Its public and you can look it up. By almost all measures, we come out strong. That doesn’t stop people from complaining though. But I have never, ever heard of a Canadian say “gosh darn, I WISH we had healthcare like in the US…” Not once.</p>
<p>FWIW, I don’t just live here. But because of one of my childs’ conditions, I’ve used both US (HMO and private when living in NYC, and now the healthcare in our province). By extensive, seeing 8 specialists and exams regularly, and several surgeries in both countries. </p>
<p>And not just with one child but take adults examples. I know, anecdotal, but still. Hubby had a kidney stone. Was treated absolutely immediately in ER. He got something in his eye-- saw 3 specialists in a row (each increasingly specialized) over course of 2 days. I had what we thought might be a heart attack- cardiac team shows up at my office, takes me to ER…treated en route and in the ER (cardiac team stayed with me until doctor took over). Once, I hit my head in a bowling alley…doctor friends insist i must go to ER, I feel fine…but got in immediately anyways. Oh, I also have a disease that causes intense vertigo. Go to ER with that- again immediately treated to calm the ‘spinning’ (its not intense pain but its almost as bad and they know it). So far so good. But broken arm? You probably wait hours!</p>
<p>BUT no where in the world is there an ER that doesn’t practice triage. Such is the nature of the beast. Good luck getting into an ER without a long wait in any major city on a Friday night. </p>
<p>Not perfect…no no no. Every system has its faults, for sure. And in every country with national healthcare (which is almost every developed country but the US) you will hear complaints…just like you hear complaints about taxes. I actually do healthcare research, on the economics and management restructuring side of things. Looking for new models to streamline, make wait times shorter, save money. </p>
<p>And sure there are news stories. Take the Alberta woman who had to delivery triplets in Idaho (?). That is a good sign…if it was ‘ordinary’ it would not make the news! These incidents are NEWSWORTHY. They are a big deal. Just like murders, or political scandals, or big thefts. I’ve never met someone with such a story. I’ve never met someone ‘worried’ about whether they will get the treatment they need. I’ve never heard of someone who said their loved one died because of the system.</p>
<p>Paying for it? I’m in the highest tax bracket, pay total income tax of about 36%…but I paid 35% when living in Manhattan.</p>
<p>Now that sounds like a thoughtful, non-political opinion, and something to think about. You’re right about the complaints. I wonder if there is a perfect system anywhere. </p>
<p>God help you with the vertigo. I have heard how awful that is, and I can barely stand it for a few seconds.</p>
<p>I suppose I just should be grateful that our local emergency room sees us instantly if required. Never had to wait more than a minute. But I can’t take it for granted that is like that everywhere. This is a nice facility in an upscale town, where I doubt they have people showing up there for routine care, and everybody either has medical insurance or pays their bills.</p>
<p>At our main hospital, we have been ordered by our internist to arrive by ambulance or you may languish there for quite a long time before you get any attention. There are a large # of people who go there for care & sit & sit & sit. Don’t know if the patients do or don’t have insurance but there has never been much movement of patients being seen there except those who arrive by ambulance.</p>
<p>The closest hospital to my mom has a horrible waiting time. When my mom was really sick not too long ago, she postponed going to the hospital because she knew she would be in the emergency room for hours. When my Dad was alive, he had a rare lung disease that bled now and then. He sat in the emergency for 7 hours spitting up blood in a pan. Then they put him in a room in the emergency room where he waited until the next morning to finally get a room in the hospital. The hospital no longer allows private practice doctors to meet patients at the emergency room and check patients in. They have to be officially checked into the ER, then the ER doctor examines patients. Then after the patient is discharged from the ER, they can be checked into the hospital. It’s a way for the ER to pay for itself because it can’t be bypassed in any way now. The procedure causes a real delay in care, however. The delay is not because of gunshot wounds or other crises. It is just that there is only one ER doctor who has to see everyone. The hospital has cut back on staff significantly, but they were able to put an entire new floor on the building. The rooms look like hotel suites but good luck finding a nurse when you need one.</p>
<p>Well, I’m SO glad our docs told us to arrive in an ambulance. That was the only reason dad & my neighbor (separate visits) were seen right away. Both were also having chest pain and neighbor had passed out, so all of those things probably helped advance them in triage. They never sat in the waiting room at all–went right in & were triaged.</p>
<p>I’m sad and surprised that your poor dad had to spit blood in a pan in the ER for 7 hours & then had to wait so long to get a hospital room. That sounds rather dreadful. Isn’t there another ER where your mom could go that could se her more promptly, even if it’s slightly further from her home? It seems like it might be worth considering & exploring. Sad that docs aren’t allowed to check their patients in and that the ONE ER doc is so over-extended. I’m sure the quality of care must suffer considerably.</p>
<p>Now that two of the hospitals in our state have closed their doors (insolvent), ALL the other hospitals are busier than ever. The nurses I know are working longer & harder than ever. They say as soon as they discharge a patient & change the bedding, there is a new patient in the room. It’s very tiring for everyone. There must be a better way than this.</p>
<p>A nearby hospital has a pretty decent demographic, drawing from all social levels. Despite the fact that it’s not a super-distressed inner city facility, it still has a waiting time in the ER of up to 16 hours. Car accidents and suspected heart attacks will get in much sooner, but if you’re not dying on the floor (at least, so far as they know), the wait is horrendous. They’ve had to institute meal service to the ER.</p>
<p>"And how many of those programmers have required education of 10-12 years? You’re trying to compare apples to oranges here… "</p>
<p>-Somebody (not me) digged up statistics that about 25% of Med. Students are graduating w/o debt (parents paying). And it is not 10-12 years without pay as after UG + Med. School, residents are actually paid, as low as maybe $50k/year, they still can live independently on this income. Second consideration, not every programmer is loan free either. I am, because my employers paid for my degrees. We have young programmers in our office that have student loans. They are considerably lower than potential loans of Med. Students. But as I have mentioned, job security and compensation of programmer in our area are also considerably lower than MD’s.</p>
<p>DH went to school for 10-12 years and gets paid a fraction of what physicians make. I certainly don’t begrudge a physician for making a high salary and feel that DH deserves what the market will bear. The high salary is due to the high risk and specialized skill. It’s not because physicians go to school for 10-12 years. If that was the case, we’d be paying college professors, the PHD who teaches HS, researchers…a whole lot more money than they get.</p>
<p>If it takes somebody 6 - 8 years fulltime beyond an undergraduate degree to get a Ph.D., they’re in the wrong field.</p>
<p>Umm, it occurs all the time in basic research.</p>
<p>My professor told a story about how one of his colleagues had been working on his PhD for seven years before making one of the biggest discoveries of his field.</p>
<p>That’s because you can’t actually finish your PhD until you discover what you set out to discover.</p>
<p>Possibly DocT, but in this country, we don’t pay more because someone went to school longer.</p>
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<p>Unfortunately, slightly further from home in that area is at least 1 1/2 hr. drive away. That is not something she wanted to ask a neighbor to do in the middle of the night. There are waits in those ERs too, unless you in critical condition. Her doctors are at the hospital so it doesn’t make sense to be admitted that far away. If she were to need surgery, she would go to a hospital that far away.</p>
<p>"Umm, it occurs all the time in basic research.</p>
<p>My professor told a story about how one of his colleagues had been working on his PhD for seven years before making one of the biggest discoveries of his field.</p>
<p>That’s because you can’t actually finish your PhD until you discover what you set out to discover. "</p>
<p>That’s quite interesting. Your last statement is incorrect - I restarted my basic research several times and came up with a “discovery” that had nothing to do with what I initially set out to do and got my Ph.D.</p>
<p>"Possibly DocT, but in this country, we don’t pay more because someone went to school longer. "</p>
<p>Untrue - when you are required to go much longer as in medicine, you are paid more and that is one reason mds typically make more money.</p>